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Eye Injury: Overview

Margaret Harrill

It can be said that disease occurs in
predictable ways, to predictable
groups of people and follows more or less
a predictable course of events. A
common disease that occurs in the eye is
age-related macular degeneration (AMD).
We know that this disease occurs most
often in Caucasian women over the age of
50. We know that there is a combination
of genetic and environmental factors that
influence who is most vulnerable to this
disease. We know that untreated, the
natural course of this disease is
distinguished by its form, either dry or
wet. With the evolution of increasingly
more and more sophisticated methods of
discovering and understanding,
increasingly more and more effective
treatments and preventions have been and
are being developed for this once
inevitably disabling condition.

Can we say the same thing about
injury? Can we predict who will have an
eye injury and why? Can we say people
who have eye injuries will experience a
certain type of symptom, which will
progress in a specific way and will
respond to a distinct treatment? Is there a
foundation of historical observation and
research on which to base these assumptions?
No. Regrettably, we can not offer
the same degree of certitude to a victim of
ocular trauma today as we can to the AMD
sufferer.

It is only within the past 30 years that
two elements critical to illuminating the
dark unknown of ocular trauma have
come to pass. Early in the decade of the
1970’s, Dr. Robert Machemer pioneered
the development of vitrectomy, a surgical
method of operating inside of the globe
through microscopic portals that allow
the eye to maintain its shape and
integrity during the operation. Prior to
the advent of vitrectomy, if someone had
a very serious eye injury there was very
little that could be done. Many, if not
most, of the seriously injured eyes were
simply removed. It was not until
vitrectomy that surgeons were able to
begin to operate within the globe. Only
then could surgeons start to sort out
damage to the internal structures and find
ways to repair them.
Empowered with a way to treat
injuries, ophthalmologists became
interested in improving the results of
their work. Little was known about eye
trauma and less about the results of
ocular trauma surgery. There wasn't’t
even a common language or terminology
for discussing eye injury among different
physicians in different institutions or
countries. A decade after Machemer’s
advance, a registry for eye injury
statistics was formed in Alabama. It was
to become the genesis for the United
States Eye Injury Registry (USEIR), a
project of the Helen Keller Foundation.
Thanks to the research of the Registry,
many of the gaps in information about
eye trauma are beginning to be filled in.
Registry research has enabled the
creation of a universal terminology for
describing injury, the Birmingham Eye Injury Terminology (BETTS). Foundation scientists
have also been able, with the Registry
data, to develop the Ocular Trauma Score
(OTS), a program for prognostic
evaluation of injury.